Using a passport to cut the costs of surgery

To save money, boomers and retirees are going abroad for operations and dental work

Used to be, you’d only hear about medical tourism after a celebrity would go to Europe for a face-lift. These days, you’re more likely to hear about your neighbor going to Mexico for new teeth. Yet despite its democratization, medical travel remains in many ways a cottage industry, fraught with potential perils for unsuspecting patients.

An estimated 900,000 to 1 million Americans will cross international borders for medical treatment in 2013, up from an estimated 150,000 in 2006, according to Patients Beyond Borders, a publisher of consumer and reference information on medical tourism. At an estimated 45% to 50%, U.S. residents traveling to Mexico or Costa Rica for dental work make up the largest segment of this roughly $10 billion market, according to Patients Beyond Borders.

The savings on medical procedures can be considerable, ranging from 25% to as much as 90%, depending on the procedure and location. In one example, Josef Woodman, CEO of Patients Beyond Borders, said that a patient needing extensive dental work who was quoted $60,000 for a mouthful of new teeth in the U.S. was charged $17,000 for the same work in Costa Rica.

Boomers make up a disproportionate number of the Americans seeking treatment abroad, experts say. That’s hardly surprising, given that some of the most popular procedures done abroad, such as dental work and orthopedic surgery, are most often performed on those whose bodies have started to show some wear and tear. Some medical travelers are underinsured or uninsured, while others seek treatment that isn’t covered by their health plans, such as cosmetic surgery or dental procedures. Medicare doesn’t cover routine dental work, making dental-procedure travel particularly attractive to the 65-and-over crowd.

Apollo Healthcare

The Apollo Hospital in New Delhi, India is one of several foreign medical facilities that are catering to budget-conscious American patients.

Starting next year under Obamacare, most people must have health insurance or pay a penalty. What’s more, health insurance will become more accessible to those with pre-existing conditions. But some consumers will still face high out-of-pocket costs, which could make medical care abroad look like a competitive option. And it’s possible that the growing ranks of the insured will lead to longer wait times for specialists, leading more patients to travel abroad for prompter treatment, Woodman said.

There are plenty of top-flight medical facilities abroad, but also plenty of doctors eager to attract—and potentially take advantage of—relatively wealthy patients, experts say. “To some providers a patient is a meal ticket, and a North American patient is an even bigger meal ticket,” said Shai Gold, managing partner at International-Triage, an international managed-care network provider that handles claims management and administration for medical care in Latin America and the Caribbean.

While some U.S. employer-sponsored health plans cover medical care abroad, for the most part individual (non-group) plans do not, experts say. Self-paying individuals looking to travel internationally have a bewildering array of options. So-called facilitators or health-travel planners connect U.S. patients to medical providers abroad. Some offer referral services only, while others also handle travel arrangements and some oversee treatment and aftercare.

While some facilitators are small operators in business for themselves, there are larger firms, such as Boston-based HealthGlobe, that refer patients to doctors they have vetted and coordinate all aspects of the travel and medical procedure logistics, such as booking appointments and transferring medical records, for a fee to the patient.

Many facilitators work on commission, creating a potential conflict of interest if they steer clients to the doctor who pays them the fattest cut, said Christina deMoraes, CEO and founder of the International Medical Tourism Chamber of Commerce. DeMoraes also runs a Brazil-based medical concierge firm that charges fees to patients, rather than collecting commissions from providers. She said she started the Chamber of Commerce a year ago in hopes of fostering standards to protect patients in the medical travel industry.

Experts offered some tips for people considering venturing abroad for medical care:

Keep expectations realistic

Before you research your international treatment options, visit a trusted doctor in the U.S. for a consultation. That way, you’ll have a baseline treatment plan as a point of comparison when talking with international providers.

Your home doctor’s assessment might also serve to keep your expectations in check. Often, patients traveling abroad are eager to make the most of their short trip and try to schedule more work than is safe in the allotted time, said Ilene Little, CEO of Traveling4Health.com. “They think about it like a 2-for-1 shoe sale,” she said. And doctors eager for business may not say no to patients’ unrealistic expectations—such as, say, getting dental implants without the required healing time before the new teeth are placed.

It’s also important to be realistic about the cost savings. If you get quoted a $4,000 price to do a dental bridge in Ohio, you’re not going to experience much if any overall savings if you get the same procedure done in Panama once you factor in travel and lodging costs, Gold said. India offers some of the steepest bargains—gastric bypass surgery, for example, costs about $9,300 there, versus $35,000 to $52,000 in the U.S., according to Patients Beyond Borders. But a weight-loss surgery patient who can’t comfortably travel in a coach seat and needs to pay for a first-class plane ticket is going to see much of that savings disappear, Woodman said.

Woodman has a general rule of thumb that if your total bill for a procedure in the U.S. is $6,000 or more, you’ll probably save money going abroad for treatment, even including travel and lodging expenses.

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